A multi-facility health system recently discovered net revenue opportunities as a result of fee schedule audits conducted during a Diagnostic Pricing Review. The health system's payer relations division worked with MedCom to provide current managed care fee schedule files at a detail level. MedCom then conducted line item analysis of the health system's current prices in comparison to both the commercial fee schedules and the standard Medicare rates. The audits discovered 998 chargemaster line items where the current price level did not meet one of the reimbursement thresholds. The resulting price update recommendations were projected to have an annualized gross revenue impact of $7.3 million, with much of that figure expected to hit the bottom line due to "lesser of charge or fee schedule" contract language.

Using a benchmark of competitive pricing data, MedCom recently performed a Diagnostic Pricing Review of the ancillary services at a flagship hospital in a seven hospital system. The project included a sensitivity analysis of various market-based pricing strategies. MedCom modeled the overall impact of the market-based price movements, layering appropriate price adjustments for defensibility metrics such as price linking and fee schedule audits into the gross and net revenue impact projections for each scenario. This high-level financial analysis showed that a line-by-line pricing review could produce an estimated $9.0 million in annualized net revenue for the hospital, with commensurate results expected at the remaining six facilities, and would also improve the health system's overall pricing defensibility.